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OMS > Anesthesia > Flashcards

Anesthesia Flashcards

1
Q

Inhibitory neurotransmitter is the central nervous system?

A

GABA (γ-amino-butyric-acid)

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2
Q

First true BZD antagonist, synthesized in 1979?

A

Flumazenil

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3
Q

Mechanism of BZDs?

A

GABA exerts its inhibitory effect by opening the chloride ion channel on neuronal membranes, thus hyperpolarizing the cell membrane and making it less likely to depolarize. BZDs bind to benzodiazepine receptors presynaptically and postsynaptically, which facilitates the binding of GABA and potentiates its activity, causing CNS inhibition.

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4
Q

Effects of BZDs?

A

Anxiolysis, sedation-hypnosis, muscle relaxation (airway reflexes and tone), anterograde amnesia, and anticonvulsant activity

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5
Q

What is Verrill sign?

A

Relaxation causing ptosis of the eyelids to the point that the lower border of the upper eyelid bisected the pupil

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6
Q

What is the incidence of anterograde amnesia in patients who received 5 mg of midazolam?

A

Complete amnesia in 67% of patients.

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7
Q

Where are BZDs metabolized?

A

Liver metabolism, renal excretion.

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8
Q

Only true contraindications of BZDs?

A

Allergy and acute narrow-angle glaucoma.

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9
Q

Diazepam negative effects?

A

Many active metabolites, long elimination half-life (20-40 hrs), not water soluble (needs solvent for IV use- propylene glycol: risk phlebitis and venous thrombosis)

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10
Q

Midazolam advantages?

A

shorter half life (1-5 hrs), no active metabolites, water soluble.

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11
Q

Half life of flumazenil?

A

Roughly 1 hr, making resedation a risk.

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12
Q

Mechanism of flumazenil?

A

Competitive antagonist, interacts with the GABA-BZD complex and competitively displaces the BZD.

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13
Q

Name some natural opioids (2)

A

Morphine, codeine

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14
Q

Name semisynthetic opioids (4)

A

Hydrocodone, hydrocodone, oxycodone, heroin

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15
Q

Name synthetic opioids (4)

A

Fentanyl, tramadol, remifentanil, meperidine

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16
Q

Types of opioid receptors (3)

A

mu, delta, kappa

17
Q

Primary desirable effect of opioids

A

analgesia

18
Q

Undesirable effects of opioids

A

Histamine release, respiratory depression, hypotension, reduced gut transit or ileus, urinary retention, opioid withdrawal

19
Q

Mechanism of respiratory depressant effect of opioids

A

Depression of brainstem response to increased CO2 and decreased O2. Low rate and large tidal volume.

20
Q

Time to clear opioids from breast milk

A

Up to 96 hrs

21
Q

Difference of meperidine effects from other opioids

A

atropine-like effects: tachycardia, decreased myocardial contractility, mydriasis

22
Q

Meperidine duration of action

A

3-5 hours

23
Q

Opioid most likely to cause histamine release

A

Meperidine, symptoms similar to anaphylaxis; also can cause vasodilation and hypotension

24
Q

How much more potent than morphine is fentanyl

A

60-80 times more potent, also 2-3 times greater affinity at opioid receptor.

25
Q

Fentanyl onset and clearance times

A

Rapid onset, rapid elimination (99% cleared from plasma in 60 min)

26
Q

Which opioid receptor does remifentanil act on

A

mu selective

27
Q

Pharmacokinetics of remifentanil (metabolization)

A

metabolized by tissue and plasma esterases which leads to extremely short half life.

28
Q

Short acting opioid antagonist

A

Naloxone

29
Q

Drug class of propofol

A

sedative hypnotic

30
Q

Propofol is not water soluble and is formulated in a lipid emulsion containing:

A

soybean oil, egg phosphatide (lecithin), glycerol, preservative (EDTA)

31
Q

Mechanism of action of propofol

A

Interacts with GABA receptors

32
Q

Hiccups and myoclonic movements occur with which drug

A

methohexital, up to 90% of the time in patients who receive it

33
Q

Cardiac effects of methohexital

A

tachycardia and hypertension, cardiac compensation for peripheral vasodilation

34
Q

Potential epileptogenic

A

Methohexital

35
Q

Clinical side effects of barbiturates

A

Respiratory depression, sedation/hypnosis, increased EEG activity, myocardial depression, decreased vascular resistance, excitatory motor effects.

OMS (9 decks)

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